Provider Demographics
NPI:1063143469
Name:MANGO, TARA (AUD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:MANGO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MONMOUTH RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1024
Mailing Address - Country:US
Mailing Address - Phone:732-229-4089
Mailing Address - Fax:732-229-3150
Practice Address - Street 1:223 MONMOUTH RD STE 1A
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1024
Practice Address - Country:US
Practice Address - Phone:732-229-4089
Practice Address - Fax:732-229-3150
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist